by Charlotte Kilpatrick | Oct 2, 2024 | Global Health |
In October 2024, CEPI announced the expansion of research into Lassa fever in West Africa in a “pioneering study” to explore the variation in disease symptoms and how this compares to other “worrisome infections” in the region. The project, led by the Nigeria Centre for Disease Control and local study sites, comes under the Enable study, created by CEPI and partners to provide a more accurate picture of the disease burden in West Africa and help inform outbreak preparedness efforts, including Lassa vaccine development. Lassa fever, a known public health burden in the region, infects “hundreds of thousands” every year. However, cases are likely underreported due to detection difficulties.
Lassa fever
Although it was described in the 1950s, the virus causing Lassa fever was only identified in 1969. It is a single-stranded RNA virus in the Arenaviridae family. The disease is a “potentially deadly haemorrhagic illness” with an estimated 1% case fatality rate. Most infections are thought to be “minimally symptomatic or asymptomatic”, which means they avoid detection. People who do experience symptoms can suffer fever, headache, and chills, and could be misdiagnosed with diseases like Ebola, dengue, or malaria.
As a WHO priority disease, Lassa fever is in “urgent need” of research and development. Understanding the disease is critical to vaccine development, which Dr Muhammad Ali Pate, Coordinating Minister of Health and Social Welfare of Nigeria, recognises.
“Lassa fever remains a public health burden in Nigeria and West Africa, but the commitment to research and innovation is yielding promising progress. The new Enable research will deepen our understanding of the virus and enhance the work being undertaken to develop the first-ever Lassa vaccine to safeguard the health of our communities.”
Dr Pate highlighted the Ministry’s commitment to collaboration to “advance these efforts and bring the suffering caused by Lassa fever to an end”.
Enable expanded
Enable was launched in 2019, and in 2021 CEPI announced funding to provide a “more accurate assessment” of the incidence of Lassa fever infections. CEPI offered US$ 10.3 million to partners in Benin, Guinea, Liberia, and Sierra Leone to participate, enrolling up to 23,000 participants to understand the “rate, location, and spread of Lassa virus across the region”. The results are also central to CEPI’s goal of producing a licensed Lassa vaccine.
The new year-long study will invite 5,000 healthy people, including children and infants, to participate at sites in Nigeria (Edo, Ondo, and Ebonyi states), Sierra Leone, and Liberia. It is intended to improve understanding on how commonly the disease occurs, how rates of infection and symptoms vary across locations, ages, sex, and exposure history, and the extent of post-infection symptoms. Scientists will also explore how often people are co-infected with Lassa fever and malaria, as co-infections may complicate the clinical course of each disease.
Vaccine goals
Dr Richard Hatchett, CEO of CEPI, explained that “incomplete detection” of cases affects both the understanding of the true incidence rate and level of response, but could also “threaten the evaluation, rollout, and acceptance of future Lassa vaccines”.
“Insights gained on the diversity of disease symptoms will enhance our understanding of Lassa fever, categorised into mild, moderate, or severe cases. This information will be crucial in guiding where and how future late-stage vaccine trials are conducted and determining priority groups for receiving the Lassa vaccine once it becomes licensed in the coming years.”
A 2024 modelling study found that around 3,300 lives could be saved over 10 years with a Lassa vaccine. It could also avert up to $128 million in societal costs. The most advanced vaccine candidate is developed by IAVI and is currently in Phase II trials in the region. Enable National Project Coordinator in Nigeria, Mrs Elsie Ilori, described the launch of the expanded study as a “key step in our ongoing efforts to understand and combat this dreadful disease”.
“Through deeper investigations into the variations of Lassa fever symptoms and their comparison to other infections within the region, we will obtain valuable insights that can improve diagnosis, boost outbreak preparedness, and inform the future vaccine development.”
Dr Jilde Idris, Director General of Nigeria Centre for Disease Control and co-chair of the Nigeria Lassa Vaccine Task Force agreed that the investigation “represents key progress in our battle against Lassa fever”.
“We are improving our capacity to identify and recognise cases while preparing for future vaccine development by examining the disease’s symptoms and its connection to other infections.”
The work is “vital for forming health practices” and “promoting” public health in the region, and Dr Idris welcomed the support of partners and local communities in “making strides towards lessening the impact of Lassa fever” and preparing for a “future that can block its life-threatening effects”.
For more on IAVI’s vaccine efforts and insights into challenge studies in West Africa, join us at the Congress in Barcelona this month for a session with Dr Marion Gruber. Don’t forget to subscribe to our weekly newsletters here for vaccine updates!
by Charlotte Kilpatrick | Oct 1, 2024 | Global Health |
A study in PLOS Global Public Health in September 2024 compares the WHO and Medicines Patent Pool (MPP) mRNA technology transfer programme with the approach and practices of current biopharmaceutical production. The programme launched in June 2021, with a hub in South Africa, and is intended to increase vaccine manufacturing capacity in low- and middle-income countries (LMICs) in response to the “vaccine apartheid” of the COVID-19 pandemic. The study finds that, despite improvements to the sharing of knowledge, other features are “in line with the status quo”.
Addressing “vaccine apartheid”
During the COVID-19 pandemic “vaccine apartheid” was used to describe the unequal distribution of vaccines against COVID-19. To address this disparity, WHO chose Afrigen Biologics to “change the global landscape of biopharmaceutical production” by developing an mRNA COVID-19 vaccine and distributing the technology to manufacturers in low- and middle-income countries (LMICs).
“Building capacity to make vaccines locally for local populations became imperative.”
WHO identified a model of knowledge-sharing that had been used in efforts to make the global influenza virus sharing network more accessible and useful to people in LMICs. The Medicines Patent Pool (MPP) was assigned the responsibility of managing the mRNA programme’s fundraising and legal needs.
“The programme has the potential to be transformative as a model of vaccine production, encompassing both upstream research and development (R&D), and ‘end-to-end’ vaccine manufacturing.”
However, the initiative faces “several risks”, such as “precarious levels of funding”, the threat of patent litigation by establish manufacturers, and a variety of governance issues as it seeks to develop the capacity for producing high-quality mRNA-based technologies to protect against a range of diseases.
The study
The authors used qualitative research methods to explore the extent to which the WHO/MPP-managed programme differs from current biopharmaceutical production. The “situational analysis” combined data collection and analysis of multiple data sources. In document analysis they analysed “multiple types of documents”, including legal documents, agreements, correspondence, and patent applications.
The approach also involved a purposive sampling strategy, engaging people in leadership positions. Interviews were conducted with executives and officials, scientists, WHO and MPP officials (the “programme’s architects”), representatives from vaccine manufacturers across the world (“programme partners”), and scientists and experts from the global North. The study begins by exploring the programme’s origins, from 2020 to 2021, before comparing its design to four paradigmatic features of global biopharmaceutical production as identified in literature and “numerous scholarly disciplines”:
- Weak conditionalities attached to publicly funded science
- Secret, transactional R&D partnerships
- A high degree of financialization
- Market-based governance
The origin story
The authors describe WHO’s efforts to improve access to COVID-19 interventions as “markedly” different in approaches to mitigating access challenges and the actors involved.
The Access to COVID-19 Tools Accelerator (ACT-A), launched in April 2020, combined public and private actors. The vaccine arm of ACT-A, COVID-19 Vaccines Global Access (COVAX), was intended to procure vaccines for LMICs through the collective purchasing power of high-income countries (HICs). However, this effort was hampered by HICs prioritising domestic populations, “at the expense of equitable global distribution”.
The COVID-19 Technology Access Pool (C-TAP) was established in May 2020, contrasting ACT-A’s charity-based approach with an effort to distribute control of intellectual property (IP), data, and knowledge. This “pooling” of technologies to address population needs in LMICs was “applauded by civil society but fiercely contested by industry, its allies, and the Gates Foundation”.
A third proposal emerged, centred on building capacity “in LMICs for LMICs”, driven by WHO’s lead coordinator for vaccine research, Dr Martin Friede, and Chair of MPP’s Governance Board and former WHO Assistant Director-General, Dr Marie-Paule Kieny. They reflected on the “hub and spoke” model of manufacturing that had been used in the context of influenza vaccines, imagining a “centralised knowledge sharing system with a view to enhancing local vaccine production capacity in LMICs”. There were “crucial questions” about how this model would work in the context of COVID-19.
WHO’s Erika Dueñas Loayza suggested that the initial plan was to embed the COVID-19 hub within C-TAP. In the face of growing industry opposition to C-TAP, the WHO Assistant Director General of Access to Medicines and Health Products at the time, Dr Mariângela Simão, and WHO Chief Scientist at the time, Dr Soumya Swaminathan, elected to move the programme closer to the ACT-A. In this context, WHO issued a call for expressions of interest for technology transfer hubs in April 2021.
Afrigen responded to this call, with Chief Executive Professor Petro Terblanche identifying an opportunity: “we are small, but we know tech transfer”. Professor Terblanche assembled a “consortium” with Biovac and the South Africa Medical Research Council (SAMRC) to apply. This appealed to Dr Friede, who commented that the consortium, and its location, were “attractive”.
Although Afrigen was announced in June 2021, Bio-Manguinhos in Brazil presented a proposal for ‘end-to-end’ mRNA manufacturing capacity transfer. Then head of vaccine innovation, Dr Sotiris Missailidis, reflected that the early impression given was that “the model was going to be a decentralised. Model” with several hubs, each with spokes.
“What I didn’t know was that, at some stage, […] there was a decision taken from WHO or whoever, that as there was increasing political and financial pressure, many people wanted to come in. […] So the decision was taken to have on central hub and everybody else would be spokes.”
The study authors convey a sense of confusion about the hub/spoke situation well into 2022. In 2024, the programme “continues to evolve”, encompassing a “diverse array of actors”. The fourteen LMIC-based “spokes” are now known as “partners” because of “negative connotations”.
Quid pro quo
The “first defining feature” of biopharmaceutical production relates to the “limited quid pro quo” that the public sector expects in return for supplying private actors with financing, R&D, and product leads. Weak conditionalities are often attached to government and philanthropic funding of biopharmaceutical R&D.
“Conventional wisdom is to grant maximum discretion to recipients of public funding, including universities and government laboratories, as well as private actors about how to commercialise biopharmaceuticals.”
From this, the authors infer that the state’s role is to subsidise, not shape, innovation. Funding for the mRNA programmes comes from governmental sources through MPP, which secured commitments from France, the European Commission, Germany, Norway, Belgium, and Canada, as well as the South African government and the African Union. The donors have committed US$117 million to the programme, which is expected to be “self-sustaining” by 2026. These funders have “shaped the programme in multiple ways”.
For example, Germany reserved funding for a staff position at the hub, but the requirement for a French or German national meant that Afrigen was unable to fill the position. Canada, the second largest donor country, stipulated that its funding should be allocated to the Cape Town hub and four countries hosting manufacturers: Senegal, Nigeria, Kenya, and Bangladesh.
“According to one interview participant, while HICs are supportive of transferring technology to LMICs, they would prefer that such transfers do not extend to the more upstream inputs into mRNA vaccine production, including novel LNPs and antigens.”
A “critical question” for the authors is if the funding secured for the programme has been “leveraged into a shared set of commitments geared towards improving equitable access”. Relationships are defined by legal agreements drawn up by MPP, granting LMIC partners a “non-exclusive, royalty-free, non-sublicensable, non-transferable, irrevocable, fully paid-up, royalty-free license” to the technology and rights held by Afrigen and Biovac to “make, or have made, use, offer for sale, sell, have sold, export or import” in their respective territories and other LMICs. LMIC partners must grant MPP a global, non-exclusive, royalty-free license to “practice and have practiced the data and the Inventions for the purposes of fulfilling its mission” that is “non-transferable, but sub-licensable”.
The “pooled, multilateral approach to knowledge production” is “rare” for the sector, which is attributed to the fact that MPP was in a “fundamentally different position”. However, the authors identify several “notable incongruities” in the legal architecture, with a risk of “fragmenting the larger, collective enterprise of improving equitable access”. For example, some partners have still not signed on, and an “unevenness” between LMIC partners and SAMRC-funded laboratories is “embedded in the programme”.
Another feature of the programme’s funding implications is that MPP “stopped short” of requiring products to be priced affordable outside a public health emergency of international concern (PHEIC). As the pathogens targeted by various partners, such as TB and malaria, are not currently designated as PHEICs, the programme does not constrain pricing decisions. Instead, there is an “assumption” that the products brough to market will “of necessity, be affordable”, to ensure LMIC governments pay for them.
On the other hand, SAMRC funded projects must ensure that “resulting products” are “available and accessible at an affordable price”. This enforceability of this expectation is called into question by a lack of experience.
“The programme’s approach reduces the pursuit of equitable access to the task of fostering more localised production. This is a logical step towards addressing local population health needs. But localised access is never guaranteed.”
Licensing limits
Partnerships in the “dominant model” of biopharmaceutical production tend to “secret and transactional in nature”, with agreements shrouded with confidentiality conditions. More open arrangements are therefore “relatively uncommon”. At the time of applying to WHO, the consortium expected to receive technology transfer from an established mRNA manufacturer. However, they “didn’t even want to talk”, so the project became a “green fields vaccine innovation”. As the journey evolved, knowledge gaps emerged and were addressed, often with the “help of outsiders”. This was occasionally “coupled with a commitment to assist Afrigen or another consortium member in gaining internal capacity”.
“Participating in the programme is a business opportunity.”
The programme’s architects are “walking a fine line between trying to seed collaboration” and “trusting all involved to thread the commitments to IP access throughout that evolving web of relationships”.
MPP as a “power broker”
Another feature of the biopharmaceutical sector is the industry’s “highly financialised character”, evident in many firms’ decisions to become publicly traded or on stock exchanges. This has implications for the strategic direction of these firms and product prices. There is “no indication” that the mRNA programme mirrors the financialization of more established biopharmaceutical companies. However, MPP’s role as an intermediary “simultaneously adds value to, and imposes a drain upon”, the programme, which the authors suggest is “not the optimal way to provide technology transfer”.
Some interviewees comment that MPP’s technology remote transfer group seems to be “micromanaging”, striving to “be in charge of everything”. If the programme fails, it would be “because of that kind of dynamic, not because the science doesn’t work”. Additionally, there is concern that MPP’s “presence and philosophy” may not work to the advantage of different participants in the programme, with one interviewee questioning why MPP and the Gates Foundation are not working together.
Market-based governance
The final feature of the “status quo” is that the direction of biopharmaceutical prodcution is “concentrated in the hands of powerful, private actors that are, at bottom, governed by the market”. Afrigen has directed its mRNA product development towards 11 potential diseases, with Professor Terblanche suggesting that priorities have not been shaped by the prospect of financial gains. She looks for the “unmet need”, but acknowledges that she may be “forced to prioritise”.
The lack of pricing commitments in Afrigen’s Grant Agreement with MPP “could be interpreted as an incentive for Afrigen to commercialise its technology” or a suggestion that the architects “did not contemplate” Afrigen generating mRNA products of its own. The potential for Afrigen to “yield to market forces” is recognised by the architects.
“The near inevitability of Afrigen’s exit in the eyes of those who designed the programme speaks to an underlying failure of imagination concerning how the mNRA programme is governed.”
The privatised governance strategy “preserves the programme architects’ control”. Indeed, the governance structure excludes “direct representation from LMIC governments”. These choices “reflect the programme’s alignment with the dominant, market-driven approach” of biopharmaceutical production.
Sticking with the status quo?
The authors find that the programme “does not substantially depart from” at least three of the four identified “status quo” features. They conclude that to “realise technology’s emancipatory potential”, more attention should be directed to “social context and structural challenges”. Their analysis shows that “the needs and perspectives of LMICs are not sufficiently centred in the programme” and that the programme works within the existing biopharmaceutical production system without relinquishing architects’ control.
“There is a significant risk that the programme, which is claimed by WHO and MPP as a collective effort to improve manufacturing capacity in LMICs for LMICs, will not solve the problem of equitable access to biopharmaceutical innovation.”
Do you agree with the concerns raised by the authors in the study? How can they be addressed quickly and effectively in the current context, or would you expect to see lessons learnt in preparation for future efforts? To share your perspectives on initiatives to improve access to essential vaccine technologies, join us at the Congress in Barcelona next month, where we look forward to welcoming Professor Terblanche among experts on the subject. Don’t forget to subscribe to our weekly newsletters for more vaccine news.
by Charlotte Kilpatrick | Sep 30, 2024 | Global Health |
Gavi announced two major funding updates at the United Nations General Assembly High-level week 2024, revealing that it is making progress in its fundraising efforts for the upcoming strategic period. The first of these updates is that the European Commission has pledged funding for the first two years of Gavi 6.0, complementing “strong support” from Team Europe and contributing to Gavi’s goal of helping to protect 500 million more children around the world. Gavi also announced an expanded collaboration with the United States International Development Finance Corporation (DFC), focussed on donor liquidity.
European support
The President of the European Commission, Ursula von der Leyen, addressed a crowd at the Global Citizen Festival on Saturday 28th September, revealing a funding pledge of €260 million for 2026-2027 and promising more to follow. The funds will support Gavi’s 2030 ambition of providing protection to 500 million more children, strengthening immunisation systems, and boosting global health security by “increasing readiness to respond to disease outbreaks”.
Added to the money pledged so far by the United States, France, Spain, and others in June 2024, this pledge takes Gavi’s total for the next strategic period to US$2.7 billion. The target is at least US$9 billion, which would enable Gavi to protect more children against more diseases, faster, and protect the world from outbreaks of disease when they occur. The €260 million pledge is for the first two years of Gavi’s upcoming strategic cycle, which coincide with the last two years of the EU’s 2021-2027 Multiannual Financial Framework (MFF). The European Commission is expected to remain committed to a “high level of ambition in supporting Gavi” as it prepares for the next MFF.
President von der Leyen reflected that “a healthier world is a better world”, with vaccination “one of our best chances for this”.
“Right now, millions of children are still at risk. We must continue to support vaccination around the world to save lives. So today I am proud to pledge 260 million euros for Gavi, the Vaccine Alliance. And more will come.”
DFC collaboration
The DFC and Gavi will expand their partnership with a focus on donor liquidity. This builds on support established during COVID-19, with the US$1 billion Rapid Financing Facility allowing Gavi to access funds quickly in the event of new donor pledges for pandemic response or routine immunisation. The mechanism is also central to Gavi’s Day Zero Financing Facility.
Nisha Biswal, DFC Deputy CEO, recognised that “global health security is economic and national security”. DFC invests in healthcare services, supply chains, and technology to strengthen pandemic preparedness and health system resilience, including over US$3 billion in health-related projects to enable over 50 million patients access healthcare.
“With the new Surge Financing Initiative, the expanded Gavi liquidity facility, and investments in regional manufacturing, we will be able to do far more to expand access to life-saving healthcare products, especially during health emergencies.”
Still on track
Dr Sania Nishtar, CEO of Gavi, expressed gratitude to the European Commission, recognising President von der Leyen’s “leadership in advancing global health outcomes” and DFC.
“Thanks to the European Commission and DFC, we remain on track to meet our target of protecting people, communities, even our entire world through immunisation.”
For more on global health investments at the Congress in Barcelona next month, get your tickets to join us here. Don’t forget to subscribe to our weekly newsletters for the latest vaccine news.
by Charlotte Kilpatrick | Sep 30, 2024 | Global Health |
The University of Connecticut announced in September 2024 that a $3.8 million R01 grant from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), will support efforts to develop universal vaccine candidates for leptospirosis. Assistant Professor Elsio Wunder, from the Department of Pathobiology and Veterinary Science in the College of Agriculture, Health, and Natural Resources (CAHNR), will work with colleagues to tackle the animal-borne disease. Leptospirosis is a “neglected disease” with no worldwide approved vaccine.
Leptospirosis
Leptospirosis is a disease caused by the Leptospira bacteria, found in contaminated water or soil. It affects animals and people, and if left untreated in humans can lead to kidney damage, meningitis, liver failure, breathing difficulty, or death. An estimated 1 million human cases occur globally each year, causing around 60,000 deaths annually. The disease is considered “neglected” because it “typically impacts poorer communities and individuals who lack access to adequate sanitation”. Neglected diseases tend to receive less attention and funding than other diseases. However, researchers like Dr Wunder are hoping to “correct this public health injustice”.
A big investment
Dr Wunder has a background in veterinary and human health and has focused on improving diagnostic and prevention mechanism for leptospirosis. The latest award will support these efforts.
“It’s a big investment from the NIH. I’m very grateful. The fact that you have this major investment in a neglected disease is a really big step.”
The team involves researchers from Yale University, the University of California-Irvine, and Serimmune, bringing “strong and diverse expertise” from various fields. They will spend five years developing vaccine candidates and testing them in animal models, hoping to find a viable candidate that is ready for testing in human clinical trials.
Universal focus
The project focuses specifically on developing a universal leptospirosis vaccine, which could be used in “any epidemiological setting in the world” and protect against disease “no matter which strain is circulating in the area”. To do this, the researchers will need to understand more about leptospirosis causing illness. Dr Wunder’s previous research produced an attenuated leptospirosis vaccine, which produces immune responses for specific strains, rather than multiple variants. However, the work behind this vaccine revealed that the bacteria’s proteins are a key target.
In the new project, Dr Wunder and collaborators will pursue a multi-recombinant protein vaccine. Vaccine development for leptospirosis is “very hard” and bacteria have “so many tools to evade host immune defences”. Therefore, the researchers have tried to use several proteins at once. The goal is to create a vaccine with small and relevant elements of these recombinant proteins and ensure that the vaccine can be produced and distributed cheaply. This would enable the best public health effect for people who suffer the greatest burden of the disease. Alongside the project, Dr Wunder will maintain his research and teaching at CAHNR.
“I teach a class that’s an introduction to pathobiology and a mix of basic and translational research, and how important translational research is to improve life for people – in terms of vaccines, treatments, and diagnostics. But in order to have translational research, you do need basic science. And this grant is very much a mix of both.”
For insights from leaders in ‘neglected disease’ research at the Congress in Barcelona next month, get your tickets to the event here, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 30, 2024 | Global Health |
In response to recent data on influenza-associated deaths in the United Kingdom and United States, experts from the UKHSA and the CDC are urging everyone who is eligible for a flu vaccine to get vaccinated. A survey from the National Foundation for Infectious Diseases (NFID) suggests that few adults in the United States intend to get vaccinated against flu, COVID-19, respiratory syncytial virus (RSV) or pneumococcal disease, expressing concerns about side effects and a “general distrust” of vaccines. A decrease in uptake has also been observed in the UK, a source of “real concern” for UKHSA.
NFID’s study
The National Foundation for Infectious Diseases (NFID) commissioned an annual survey of US adults to “better understand current attitudes and behaviours” about infectious diseases like influenza (flu) and COVID-19. The study was conducted in August 2024 and included 1,160 complete responses from adults aged 18 and over. The study found that, although 67% agreed that an annual flu vaccination is the “most effective” way of preventing flu-related hospitalisations and deaths, 45% did not plan to or were unsure if they would get vaccinated this season. Only 38% indicated intention to get a flu vaccine this year.
When asked about attitudes towards each disease, “less than 1 in 5” were concerned about themselves or someone in their family getting infected this season:
- RSV – 16%
- Flu – 17%
- Pneumococcal disease – 17%
- COVID-19 – 20%
The survey explored the “top reasons” for people who will or might get a flu vaccine to get vaccinated against flu, including:
- To protect yourself – 76%
- To protect your family – 65%
- To avoid severe complications, including hospitalisation and death – 51%
- To avoid getting sick and missing work or school – 51%
Nearly half (49%) of participants who are at higher risk for flu-related complications cited their chronic health condition as a reason to get vaccinated against flu. Almost 3 out of 4 (72%) of adults who were diagnosed with flu in the last 2 years were likely to get a flu vaccine.
Mistrust and confusion
The top reasons cited for not getting vaccinated included concerns about side effects and a lack of trust in vaccines. While 75% of respondents trust doctors, nurses, and pharmacists for information about vaccines, only 55% trust the CDC and 51% trust state and local health departments.
“Healthcare professionals remain the most trusted source of information about vaccines and play a critical role in protecting public health by providing clear, consistent, and strong vaccine recommendations.”
Data are concerning
At a press conference in September 2024, CDC Director Dr Mandy Cohen stated that in the previous flu season, “an estimated 25,000 people in the US died from flu or related complications”.
“We can protect ourselves and those we care about by getting updated vaccines to reduce the risk of serious illness from flu and COVID-19 and do more of the things we enjoy.”
CDC data indicate that the 2023-2024 flu season in the US was “moderately severe”, causing around 41 million illnesses, 490,000 hospitalisations, and 25,000 flu-related deaths. 199 children died due to flu-related illness, which matches the previous high from 2019-2020. Also at the press conference, Dr Robert H. Hopkins, Jr., NFID Medical Director, described vaccines as a “shield against illness” and an “important tool in our public health efforts”.
“The low vaccination rates among persons with chronic health conditions are of particular concern because they are more likely to develop serious and even life-threatening complications from respiratory infections.”
Dr Hopkins encouraged “everyone at increased risk” to speak to a healthcare professional about vaccination.
“Vaccines save lives, and we all play an important role in helping protect ourselves, our loved ones, and our communities from preventable infectious diseases.”
Dr Reed V. Tuckson, co-founder of the Black Coalition against COVID and chair of the board of the Coalition for Trust in Health & Science, emphasised the importance of building trust by “enhancing our support for people in using science and evidence to make personally appropriate decisions”.
“The pandemic taught us that it is possible to close some of the gaps in immunisation rates among communities of colour, but we still have a long way to go. In addition to evidence-based messaging, we know that guidance from familiar, trusted healthcare professionals working with minority communities is essential to building vaccine confidence.”
Similar concerns across the pond
UKHSA modelling suggests that in the 2023-2024 season, influenza-attributable mortality was around 2,776 deaths due to influenza, a significant decrease from 15,465 in the previous season. Estimates of influenza vaccine effectiveness (VE) against laboratory confirmed influenza in primary care ranged between 46% and 54%. Effectiveness against hospitalisation ranged from 30% in individuals aged 65 and above to 74% in children between 2 and 17 years. However, uptake was low in people with long-term health conditions (41%), 2- and 3-year-olds (44%), and pregnant women (1 in 3).
“Across eligible groups, influenza vaccine uptake in the UK was generally lower in the 2023 to 2024 season compared to the 2022 to 2023 season.”
The decrease from 2022-2023 to 2023-2024 is broken down into various risk categories:
- Aged 65 years and over: 77.8% compared with 79.9%
- Aged 6 months to under 65 years with one or more long-term health conditions: 41.4% compared with 49.1%
- Pregnant women: 32.1% compared with 35%
There was an increase observed in the 2- and 3-year-olds group, from 43.7% to 44.4%.
Get Winter Strong
A scaled-up Get Winter Strong campaign, the result of a collaboration between UKHSA, the Department for Health and Social Care, and NHS England, is set to launch on 7th October to “help reduce the impact of winter viruses on those most at risk” and ease NHS “winter pressures”. The campaign will urge people who are eligible to get their flu and COVID-19 vaccines when invited, and (for the first time) will encourage pregnant women to get RSV and whooping cough vaccination. The maternal RSV vaccine provides “strong protection” for newborns in their first few months of life, when they are at the greatest risk of severe illness from RSV.
Dr Gayatri Amirthalingam, UKHSA Deputy Director of Immunisation, emphasised that “getting vaccinated ahead of winter is by far your best defence” against the “many dangerous viruses circulating in our communities”.
“If you’re pregnant or have certain long-term health conditions, you are at greater risk of getting seriously ill. Older people and young infants with flu are also much more likely to get hospitalised. So, if you or your child are offered the flu, COVID-19, or RSV vaccines, don’t delay in getting them. Please speak to your nurse or doctor if you have any concerns.”
Maryam Sheiakh from Manchester is quoted by UKHSA reflecting on her experience with her daughter’s flu infection. Saffy, aged 4 at the time of infection, spent a week in hospital and was transferred to a High Dependency Unit. Luckily, Saffy made a full recovery, and Maryam encouraged parents to ensure that their children get vaccinated.
“Just go and get it, don’t take the risk. No parent wants to watch their child suffer like we did with Saffy.”
The Get Winter Strong campaign will last 10 weeks, appearing on television, radio, poster sites, and social media channels. What efforts are your national health agencies making to encourage vaccination ahead of the flu season, or how are they communicating the risks of infection and benefits of vaccination?
To discuss flu vaccine development and strategies with your colleagues at the Congress in Barcelona next month, get your tickets here, and don’t forget to subscribe to our weekly newsletters for the latest vaccine news.
by Charlotte Kilpatrick | Sep 27, 2024 | Global Health |
WHO and TikTok announced a year-long collaboration to provide “reliable, science-based health information” in September 2024. The partnership seeks to address the challenges of misinformation and disinformation on digital channels by “promoting evidence-based content and encouraging positive health dialogues”. TikTok is a social platform where users create and share short-form videos.
The Fides network, a “network of healthcare influencers” who seek to share “good health content” and tackle misinformation, was launched in 2020. It has over 800 creators with a reach of 150 million people on various platforms. Network creators across the globe will be joining TikTok to create and promote evidence-based content. TikTok is also making a $3 million donation to support WHO’s work on “destigmatising mental health conditions and creating an informed, empathetic, and supportive online community”.
Social channels as a source
WHO recognises that social media platforms are important sources of information that can influence health-related behaviours and decisions. It states that one in four young adults seeks news content on social media platforms such as TikTok. However, these digital channels are increasingly allowing the distribution of misinformation and “malinformation”. Thus, the collaboration will “expand efforts” on several health topics, making science-based information “relatable and digestible”, and offering support for influencers through TikTok’s creator training programmes.
WHO’s Chief Scientist Dr Jeremy Farrar hopes that the collaboration will prove to be an “inflection point in how platforms can be more socially responsible”.
“The intersection of health and technology presents an opportunity to reach people of all ages, where they are, when they want to access. By working with TikTok and others, we are helping people access credible information and engage in scientific discourse that collectively helps shape a healthier future for all.”
Dr Alain Labrique, WHO’s Director of Digital Health and Innovation, reflected that “creators who understand their audience’s needs have a unique opportunity to bridge the gap between science and everyday life”.
“This is where WHO can step in to support influencers in delivering evidence-based information, ensuring that health conversations on platforms like TikTok are both impactful and informed.”
TikTok’s Global Head of Trust and Safety, Outreach and Partnerships, Valiant Richey, commented on the importance of TikTok’s commitment to providing “reliable information”.
“We are delighted to be partnering with the World Health Organisation’s Fides network of healthcare content creators to further strengthen this commitment by bringing engaging and authoritative mental well-being content to our community.”
Creators leading the field
Dr Timothy Tiutan has created a community of almost 2 million followers on social media and hopes that the initiative will enable creators to “empower communities to live healthier lives”.
“The network tackles global health challenges in an era where access to health information has dramatically evolved. WHO Fides is a driving force in shaping a healthier, more informed global community for the future.”
Avisha NessAiver specialises in translating research into accessible language and has worked with Fides and the UN as part of “Team Halo”. His content has reached over 100 million views on various platforms.
“The Fides network is the catalyst transforming isolated scientists and health experts into a powerful collective force, armed with shared knowledge and strategies to effectively combat the spread of health misinformation.”
Do you think this initiative will be an effective way of engaging social media users in reliable information? Or will the partnership ruffle feathers online and in the lab?
To discuss the importance of effective communication and translating the latest research into accessible content with your colleagues at the Congress in Barcelona next month, get your tickets here, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 27, 2024 | Global Health |
A study in The Lancet Public Health in September 2024 evaluates the measles dynamics in England between 2010 and 2019 to understand the effects of waning of vaccine-induced immunity. The researchers find that, although the MMR vaccine remains “highly protective” against measles infections for decades, and most transmission is “connected to people who are unvaccinated”, breakthrough infections in vaccinated individuals aged 15 years or older are “increasingly frequent”. However, they emphasise the importance of adequate coverage alongside vaccine effectiveness.
In England, measles “follows typical near-elimination transmission dynamics”, with “sporadic localised outbreaks and high national vaccine coverage”. England reached measles elimination status after “large outbreaks” between 2011 and 2013. From 2017 onwards a resurgence has been observed.
Highly protective vaccines
The authors describe measles vaccines as “highly protective against infection” recognising that they enabled a “great decrease in the global burden of measles” after immunisation programmes began in the 1970s and 1980s. Indeed, some countries became eligible for an elimination status since 2000 after the successful implementation of routine immunisation programmes. However, this is slipping out of reach for many countries in Europe and the Americas, which have reported a resurgence between 2015 and 2020.
“This resurgence was mostly reported in under-immunised communities and linked to past variations in vaccine coverage.”
Further outbreaks have been reported in “highly vaccinated” groups in Portugal and Japan, inviting questions about the waning of measles immunity in adults who had received two doses in childhood. Research suggests a waning of antibodies in young adults who had received two doses of vaccine “more than 20 years earlier”, in contrast to no decrease in previously infected individuals. Analysis of outbreak data suggest a “drop” in vaccine effectiveness in young adults who had received two doses of vaccine. However, effectiveness estimates appear to be “sensitive to assumptions on infection-induced immunity”.
The study
The study addressed the need to understand whether the measles case dynamics of settings with high vaccine coverage result from a waning of vaccine-induced immunity or if changes in the distribution of immunity in the population are driving the distribution of vaccine status among cases. A mathematical transmission model, stratified by age, region, and vaccine status was used to evaluate whether the measles dynamics in England from 2010 to 2019 were “in line with a waning of vaccine-induced immunity”. Three scenarios were modelled:
- Vaccinated individuals might only become infected because of primary vaccine failure
- Vaccinated individuals might become infected because of primary or secondary vaccine failure, with the risk of secondary vaccine failure depending on age
- Vaccinated individuals might become infected because of primary or secondary vaccine failure, with the risk of secondary vaccine failure depending on age and time since measles stopped being endemic
Each scenario was fitted to measles case data reported in England between 2010 and 2019, and the authors compared the resulting performance. Data were collected by UKHSA (formerly Public Health England), and included date of symptom onset, region of residence, age, and vaccine status. The final case dataset included 7,504 cases. The annual proportion of individuals who had been infected with measles and received two doses of the vaccine out of the overall number of individuals with measles was three times higher in 2019 than in 2011. The median age of individuals with measles was 12.5 years.
Results
Scenarios integrating waning of vaccine-induced immunity “better captured measles case dynamics” than the scenario without waning. In the scenario where waning started in 2000, the estimated waning rate was 0.039% per year.
“Although slow, waning was associated with an increased burden over time; setting the waning variable in this scenario to 0 led to a substantial decrease in cases.”
While overall vaccine effectiveness was estimated to stay high over the decades, the estimation suggested that the increasing number of breakthrough infections contributed to the measles burden in England. The additional burden brought by waning is “directly related to the risk of transmission from vaccinated cases”, as individuals infected by people who had been vaccinated would not have otherwise been infected.
“Our results suggest that the waning of vaccine-induced immunity likely explains the observed dynamics and age distribution of vaccinated measles cases in England between 2010 and 2019.”
Low vaccination rates a bigger factor
Dr Alexis Robert, Research Fellow in Infectious Disease Modelling at London School of Hygiene and Tropical Medicine (LSHTM) drew attention to the “biggest factor for measles outbreaks”: low vaccination rates. Dr Robert emphasised that the MMR vaccine is “highly effective” and two doses “will protect you and those around you”.
“This 0.04% waning each year is relatively slow, but because measles is so infectious, over time, this would add up to a ‘gap’ in a population’s defences the virus can exploit, which may increase the duration and size of outbreaks.”
The data patterns in the study emerge “because outbreaks have occurred as a result of declines in vaccine coverage”, said Dr Robert.
“If there were no outbreaks, this small amount of waning would not show up in any data. The key issue here is coverage, not the effectiveness of the vaccine.”
Dr Anne Suffel, co-author from LSHTM, agreed that the study “looks at one small part of the picture” and recognised that the “larger issue” is that “uptake of the MMR vaccine has been decreasing in England since 2015”.
“Understanding the impact of vaccine immunity waning will help anticipate the potential impact of measles in countries where incidence has been low for decades, but vaccine uptake is reducing. The best way to limit the impact of measles and protect everyone from what can be a horrible disease, is to keep vaccine uptake as high as possible.”
Dr Adam Kucharski, Professor of Infectious Disease Epidemiology and co-author from LSHTM, acknowledged the role of “other factors” such as “changes in testing patterns over time”.
“However, the consistency and age distribution of the increase in England – combined with reports of cases in vaccinated individuals in other countries and previous laboratory studies showing a decline in measles antibodies – suggests a biological explanation is involved.”
Join us at the Congress in Barcelona next month to explore the reasons for a resurgence in measles from an uptake perspective, and don’t forget to subscribe to our weekly newsletters for more vaccine news.
by Charlotte Kilpatrick | Sep 26, 2024 | Global Health |
A $4.2 million Programme Project Grant renewal from the National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases (NIAID) in September 2024 will fund efforts by researchers at Weill Cornell Medicine to develop a cytomegalovirus (CMV) vaccine. The vaccine is intended to prevent the transmission of cytomegalovirus from mother to baby during pregnancy. The grant could be extended for five years and $20.4 million to enable research to accelerate the vaccine’s development.
Protecting the foetus
Cytomegalovirus (CMV) is the most common congenital infection worldwide, but Dr Sallie Permar, chair of the Department of Paediatrics at Weill Cornell Medicine, hopes to find a vaccine that prevents transmission of the virus to the developing foetus. Around 1 in 200 babies is born with CMV, with one-quarter of them experiencing long-lasting effects such as hearing loss, microcephaly, developmental delays, and seizures. Dr Permar compares the effects to those recognised in the Zika epidemic, commenting that CMV “affects ten times as many infants”.
“If we could eliminate this terrible congenital infection, we would give more babies the chance to achieve their full potential in life.”
A model of transmission
More than half of all adults live with CMV, but if it is acquired for the first time during pregnancy, the mother has a 30% to 40% chance of passing the virus to her baby. As it is “challenging” to design a clinical trial large enough to assess the effectiveness of a CMV vaccine to protect the foetus, Dr Permar has created a collaborative network. With researchers at the University of California Davis Primate Centre, Tulane University, and Oregon Health Sciences University (OSHU) and Primate Centre, Dr Permar has developed a non-human primate model of congenital CMV transmission to test vaccines.
“This work requires a cadre of multidisciplinary virologists, immunologists, pathologists, physicians, and veterinary scientists who all care deeply about eliminating this devastating childhood infection through vaccination.”
Tackling “immune-evading tactics”
Dr Permar states that CMV has “multiple strategies” for evading host immunity; the virus conceals itself in a person’s cells and producing factors to catch host antibodies, disable common killer T cells, and cause confusion for the antiviral immune response. With the latest grant renewal, the researchers will explore approaches for “thwarting these viral immune-evading tactics”.
The team will use weakened viruses and some of the virus’ own protein factors as antigens to induce the production of antibodies against “CMV’s evasive manoeuvres”. They hope to have a prototype for a vaccine in five years, at which point they could advise the industry on vaccines that are currently in clinical trials.
For insights into maternal vaccine challenges and strategies at the Congress in Barcelona next month, get your tickets to join us here, and don’t forget to subscribe to our newsletters for regular vaccine news.
by Charlotte Kilpatrick | Sep 26, 2024 | Global Health |
In September 2024 Africa CDC and IAVI announced the signing of a Memorandum of Understanding (MoU) to enhance the continent’s capacity to fight disease, pandemic readiness, and supply resilience. This will involve expanding capabilities for locally driven research, development, manufacturing, and supply of priority vaccines and antibodies as well as strengthening Africa CDC-led initiatives. The partnership will combine IAVI’s “expertise in vaccine and antibody development and access” and the “extensive network and Africa CDC”.
Initiatives under the MoU
The MoU is intended to tackle pressing public health challenges and promote long-term health security. Some of the key initiatives under the MoU include:
- Supporting the development of vaccines and antibodies for regional health priorities (like Lassa fever and HIV)
- Fostering a sustainable supply and demand ecosystem for priority products in the region (including monoclonal antibodies)
- Strengthening African research and development capacity
- Exploring regional stockpile strategies for licensed and investigational products to ensure rapid responses during health crises
The MoU exemplifies the “action-oriented partnerships” that Africa CDC’s New Public Health Order demands as the organisation drives its vision for “redefining global health architecture” and ensuring that Africa and the world are better prepared for future health threats. IAVI recognises the support of funders and partners, including Wellcome, CEPI, the European and Developing Countries Clinical Trials Partnership (EDCTP), the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through the Accelerate the Development of Vaccines and New Technologies to Combat the AIDS Epidemic (ADVANCE) programme.
Dr Mark Feinberg, IAVI President and CEO, described the cooperation as a “key step” in IAVI’s mission to “improve global access to biomedical innovations and safeguard public health”.
“It goes beyond R&D; it’s about creating a vibrant health innovation ecosystem that meets current and future needs across Africa.”
We look forward to welcoming senior representatives of IAVI back to the Congress in Barcelona next month to learn more about the various efforts and initiatives they are enabling in pursuit of global health goals. Get your tickets to join us there and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 25, 2024 | Global Health |
At the United Nations General Assembly High-Level Week in September 2024, CEPI launched a new Biosecurity Strategy to bolster global health security and emphasise its commitment to addressing emerging epidemic threats. The strategy draws on the latest technologies and encourages international collaboration to mitigate the risks presented by emerging pathogens. This is a “significant step” in the “evolution” of CEPI, positioning it as a “though leader in the rapidly developing fields of biosafety and biosecurity”. Chair of CEPI’s Board, Professor Jane Halton, positioned the 100 Days Mission at the centre of this strategy and highlighted the significance of “security and equity” in this effort.
“To underpin that strategy, and to ensure the world can achieve the 100 Days Mission goal safely and securely, we need a robust, collaborative approach to maximising the benefits of new technologies and reducing their potential threats to human health.”
Remaining vigilant and stepping up
Dr Richard Hatchett, CEO of CEPI, writes in the foreword of the importance of remaining “vigilant” and being able to respond quickly to infectious disease outbreaks in an era of “heightened epidemic and pandemic risk”. He reflects that COVID-19 demonstrated the “devastating global consequences” of a pandemic and, through the “persistent controversy” over the origins of the pandemic, heightened awareness of the risk of accidental release and deliberate misuse of science.
“Most risk created by advances in the biological sciences derives from the fungibility of the tools designed to solve specific problems. The tools that will solve a pressing problem are empowering – but there is no intrinsic limit to their application.”
Dr Hatchett acknowledges the problem of “dual use” in the way that biologists tackle problems. However, he warns against imposing limits on scientists, suggesting that this could present “practical challenges” and “impede our progress towards legitimate and worthy goals”, among which is the 100 Days Mission.
“Global scientific participation is critical to the success of the 100 Days Mission and will enable vaccine research, development, and manufacturing to take place in communities that need it, led by those who will benefit from it, and informed by the priorities of the vulnerable communities that are disproportionately impacted by epidemics and pandemics.”
To address the risk of accidents or misuse, Dr Hatchett highlights the importance of mechanisms to “ensure that the highest, most current standards of biosecurity and biosafety are practiced and maintained”. CEPI’s “highly diverse” research portfolio includes more than 50 countries, each with “highly variable” oversight practices. The need for a biosecurity strategy is directed by a recognition that “as a steward of global funds, no matter where those funds are deployed, we have a critical responsibility to ensure that the research we fund does not lead to the next accident or deliberate incident”.
‘Beyond this threshold obligation, CEPI also has an opportunity to step-up as a thought leader in this emerging area.”
In developing the strategy, CEPI engaged more than 150 entities in the global health and security ecosystems in a consultative process and sought advice from a Biosecurity Strategy Group. Although technological capabilities will evolve and “boundaries blur between disciplines”, the strategy anticipates that “traditional approaches” may prove “inadequate” in the face of emerging threats. Thus, stakeholders must collaborate and develop mechanisms to encourage responsible use, supported by CEPI.
Biosafety and biosecurity
The strategy acknowledges the evolution of the terms biosafety and biosecurity, comparing the WHO (2024) definition of biosecurity with FAO’s (2007) understanding of the term. CEPI’s biosecurity and biosafety priorities must align with its mission to accelerate vaccine development towards the 100 Days Mission. The strategy outlines how an “innovative approach…frontloaded towards preparedness”, can enable the safe and secure delivery of this goal.
Top vulnerabilities
Several biosecurity and biosafety vulnerabilities are identified and considered relevant to the strategy:
- Variable biosafety and biosecurity oversight, risk identification, and management practices among life science funders for research involving high consequence pathogens, including CEPI.
- Substantial variations in biosafety and biosecurity policies, regulations, practices, and competencies where CEPI-funded research takes place, and insufficient health and security collaboration.
- The intersection between biosecurity and equity is insufficiently recognised, which threatens progress towards the 100 Days Mission and future responses to epidemic and pandemic threats.
- Emerging biotechnology and converging technologies present dynamic and evolving biosecurity risks that threaten 100 Days Mission progress.
- The world is insufficiently harnessing technological innovation to reduce safety and security vulnerabilities of the 100 Days Mission.
Focus and priorities
CEPI’s biosecurity focus is to “protect society from epidemic and pandemic threats, with an emphasis on preventing accidental and deliberate misuse of pathogens associated with CEPI-sponsored research”. The strategy therefore addresses global biosecurity vulnerabilities to accelerate current strategic goals with the following priorities:
- Strengthen biosafety and biosecurity risk identification, mitigation, and oversight by CEPI and encourage similar efforts by other life science research funders.
- Enhance global biosafety and biosecurity capabilities of CEPI partners for achieving the 100 Days Mission safely and securely and promote health-security partnerships.
- Drive biosecurity and biosafety in support of equity.
- Monitor and reduce emerging biotechnology and converging technology risks across CEPI’s vaccine research, development, and manufacturing portfolio.
- Accelerate biosafety and biosecurity innovation for vaccine research, development, and manufacturing.
More to come
An implementation plan of activities, goals, and timelines will follow the strategy. It will explore how priorities can be integrated into the wider mission and mandate in three major categories:
- Catalysing strategic partnerships and coalitions
- Advocacy and coordination
- Supporting biosafety and biosecurity capabilities development
Director General of Africa CDC, Dr Jean Kaseya, expressed enthusiasm at the strategy launch and its support of Africa CDC’s efforts.
“With a focus on laboratory systems strengthening, training and infrastructure development, and reducing risks of artificial intelligence and other innovations, the strategy is informed by vulnerabilities across a wide range of resource settings and will help galvanise global progress toward safely and securely achieving the 100 Days Mission.”
Trevor Smith, Deputy Director at Global Affairs Canada and member of the CEPI Biosecurity Strategy Group, welcomed the focus on “effective collaboration between the health and security sectors”.
“The strategy articulates an ambitious vision for reducing vulnerabilities and strengthening global health security.”
For insights from senior representatives of CEPI at the Congress in Barcelona next month, get your tickets to join us here. Don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 25, 2024 | Global Health |
A study in Patient Education and Counselling explores the experiences of primary care physicians (PCPs) with vaccine-hesitant patients in the hope that specific challenges can be addressed to support efforts to increase vaccine acceptance. All the PCPs who participated understood the significance of discussing COVID-19 vaccination, but they found strategies targeting people’s thoughts and feelings were “generally ineffective”. They also expressed “frustration” at their interactions with vaccine hesitant patients, which sometimes led them to “truncate their communication with these patients”.
Fostering acceptance and increasing uptake
The authors describe vaccine hesitancy as a “major public health threat” as demonstrated in the COVID-19 pandemic; an estimated 234,000 deaths could have been prevented through vaccination between June 2021 and March 2022 when COVID-19 vaccines were “widely available” in the United States. Despite this availability and evidence of vaccine effectiveness, around 20% of the US population is undervaccinated against COVID-19.
“Strategies to foster vaccine acceptance and increase COVID-19 vaccination are needed.”
Many evidence-based strategies for healthcare organisations to promote vaccine uptake put health care providers (HCPs) at the centre, with doctors “consistently cited” as a trusted source of information. However, the perspectives of primary care providers (PCPs) are a research gap. Thus, the authors identified a need to generate a “more in-depth understanding” of PCPs’ experiences communicating with vaccine hesitant patients. This understanding is a “critical first step to maximising the potential for PCPs to promote COVID-19 vaccination”.
The study
The study was intended to describe PCPs’ experiences and perspectives on COVID-19 vaccine communication with patients, with a focus on COVID-19 vaccine hesitant patients. The researchers conducted focus groups with PCPs from 3 healthcare systems in central Massachusetts. Acknowledging prior research that documents higher rates of COVID-19 vaccine hesitancy among members of racial/ethnic minority groups and those with socioeconomic disadvantage, the authors chose clinics from 3 health systems that serve higher proportions of patients who are a member of a racial/ethnic minority group, primarily speak a language other than English, and/or are insured through MassHealth.
Nine focus groups, conducted for around an hour over Zoom between December 2021 and January 2022, involved 40 PCPs. These included 23 attending physicians, 10 resident physicians, 6 nurse practitioners, and 1 physician assistant. Experiences were characterised by the following themes:
- Importance of and perceived responsibility for discussing COVID-19 vaccination with their patients
- Strategies for promoting COVID-19 vaccination
- Challenges PCPs encountered
- PCPs’ reactions and emotions
- Tailored communication according to degree of hesitancy
- Resources that would be helpful to support these conversations
The findings were integrated with the Increasing Vaccination Model, but the authors added the challenges encountered among “staunchly vaccine hesitant patients” and resultant frustration, truncated communication, and shifting priorities.
Study findings
All participants perceived discussing COVID-19 vaccination with their unvaccinated patients as “extremely important” and described feeling responsible for providing patients with accurate information about vaccination and recommending vaccination to all their unvaccinated patients. However, most PCPs did not feel responsible for whether their patient chooses to get vaccinated.
The focus groups revealed a range of communication strategies for influencing COVID-19 disease risk appraisal and/or increasing confidence in the vaccine. For example, facts and statistics appeared “ineffective”, directing PCPs to other strategies such as emphasising a patient’s risk of disease, sharing stories of other patients who experienced serious illness, and highlighting the risk of Long COVID. Some PCPs acknowledged “explicitly trying to induce fear about COVID-19″.
The main strategy for increasing vaccine confidence across PCPs was sharing information, including referring to studies and/or CDC information, answering questions, acknowledging risks, and addressing myths and misconceptions. Many PCPs presented vaccination as a risk/benefit calculation, emphasising safety by comparing the small number of vaccine-related adverse events with the number of people who had received the vaccine. They also put the risk of vaccine-related adverse events into the context of the larger risk of dying of COVID-19 or risks inherent in everyday activities.
PCPs explored various relationship-based strategies to promote COVID-19 vaccine uptake, including making personalised recommendations for vaccination, leveraging pre-existing relationships, sharing personal decisions to be vaccinated, and building trust. Common approaches to build trust included avoiding making patients feel stigmatised, acknowledging concerns and uncertainty, encouraging repeated discussions, empathising with concerns, and being explicit that PCPs are motivated by the patient’s interests. Although many offered patients a chance to ask questions, only a few reported trying to find common ground and empathise with concerns. However, those who did found it helpful.
“COVID-19 vaccine availability in clinic was consistently cited by PCPs as one of the most influential factors in getting their COVID-19 vaccine hesitant patient vaccinated.”
PCPs observed that vaccine availability overcame practical barriers, and those who worked at clinics without vaccine availability described it as a “major barrier”. Other practical challenges included inadequate time and competing medical priorities, as well as difficulty following ever-changing information on COVID-19 and vaccinations.
Efforts to influence the most “staunchly vaccine hesitant” patients’ thoughts and feelings were “generally ineffective”. Many PCPs reported struggling to overcome strongly held beliefs based in misinformation or conspiracy theories. For some, patients refused them a chance to discuss it, including those who prevented PCPs from leveraging their relationships.
“All PCPs felt frustrated and defeated with not being able to convince some patients to get vaccinated.”
This experience was compounded by the “disheartening” transition between attending to critically ill patients with COVID-19 in the ICU and being unable to get through to patients who have access to a preventative intervention. PCPs also expressed “frustration and anger” with unvaccinated patients who sought treatment for COVID-19 and described “emotional exhaustion” with trying to discuss vaccination with hesitant patients.
“Recognising that most of their strategies were ineffective among the most staunchly hesitant patients, most PCPs tailored their communication according to the degree of COVID-19 vaccine hesitancy.”
Patients were broadly categorised as those who were:
- Very easy to convince or just want PCPs’ confirmation
- Undecided but open to and seeking information
- Staunchly opposed to vaccination
The “staunchly opposed” group demanded the most time and effort, often rejecting data and/or science and having fixed belief systems informed by misinformation, politics, and personal experience. Most PCPs therefore limited the time they committed to discussing COVID-19 vaccination with patients who seemed staunchly opposed. This was also influenced by a desire to maintain relationships and ensure patients continue to seek care for other conditions.
The participating PCPs felt “ill-equipped” to communicate with their most hesitant patients but commented on the value of focus groups for learning from peers and feeling less alone in facing challenges. They expressed interest in easy-to-understand patient-facing educational materials to address common myths, questions, and concerns in multiple languages. They also indicated a desire for accurate, up to date, and easy to find information sources for their own reference. It might also be valuable to develop system-level resources to identify unvaccinated patients, conduct outreach, and offer professional counselling.
Implications and conclusions
“As the spread of medical misinformation and disinformation is expected to persist and potentially increase, our study illustrates the need for innovative and effective strategies for refuting misinformation related to vaccination, and health misinformation more broadly.”
The authors comment that “very few PCPs” in the study described empathising and expressing understanding with their vaccine hesitant patients, but the few who did found it “quite effective”. Expressing empathy and understanding the viewpoint of a staunchly vaccine hesitant patient are “necessary first steps to establishing trust with this population” before refuting misinformation. However, this is “understandably difficult” for healthcare providers.
The paper identifies a need for training in effective approaches for countering misinformation and communication. As a presumptive-style recommendation is the “most well proven provider-based strategy” for encouraging vaccine uptake, PCPs should be trained in making presumptive-style recommendations. However, the effects of this training could be limited if COVID-19 vaccine availability in primary care clinics is “inconsistent”. Efforts should focus on increasing in-clinic availability as an “important first step”.
Associate professor of medicine at UMass Chan Medical School and principal investigator, Dr Kimberly Fisher reflected that the key message from PCPs was “universal frustration” at the number of patients they “couldn’t get through to, despite their pre-existing relationship and feeling like the patients really trusted them”. This challenge continues as advice changes.
“In the early communication, public health officials obviously didn’t know that it would be required every year, and so I think there is a degree of frustration among patients about actually needing to get one every year, like a flu shot.”
Dr Fisher recognised the importance of tempering vaccine advocacy with maintaining a trusting relationship.
“Maybe they won’t get vaccinated. But you could still convince them to get a mammogram or colonoscopy or something else.”
For more on effective vaccine communication and encouraging participation in necessary immunisation strategies, get your tickets to join us at the Congress in Barcelona next month, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 23, 2024 | Global Health |
In September 2024, WHO described “significant progress” on government-led negotiations on a pandemic agreement after another round of discussions. These discussions took place at the 11th meeting of the Intergovernmental Negotiating Body (INB) between 9th and 20th September in Geneva. Further discussions are scheduled from 4th November.
The pandemic agreement is an effort by WHO Member States to strengthen pandemic prevention, preparedness, and response. The intention to negotiate this agreement was established in December 2021. In June 2024, governments made “concrete commitments” to complete negotiations within a year at the latest.
Collective commitment
WHO Director-General, Dr Tedros Adhanom Ghebreyesus, commented that the “collective commitment” shown in the efforts to reach an agreement is a necessary response to the threat of viruses with pandemic potential.
“The next pandemic will not wait for us, whether from a flu virus like H5N1, another coronavirus, or another family of viruses we don’t yet know about. But all the ingredients are in place to meet the objective of countries to negotiate a generational pandemic agreement. The world needs hope that it is still possible for countries to find common solutions to common problems. You provide that hope.”
Ambassador Anne-Claire Amprou, INB Bureau Co-chair of France, also identified the “visible commitment” shown by governments in the negotiations.
“There was a clear recognition from all countries that we must agree on a way forward to work better, together, to protect their citizens from future pandemics… The constructive contributions by INB relevant stakeholders were incredibly valuable. Together, we must sustain this progress during the coming months to realise our shared goal to forge a pandemic agreement that guides future global responses to pandemics.”
Head of Pandemics at FOUR PAWS, a global animal welfare organisation, Nina Jamal, centred a One Health approach in the “growing urgency” for an effective Pandemic Agreement.
“We thank the Bureau for transparency towards relevant stakeholders, increased openness and constructive proposals by Member States, promoting successful negotiations. We are looking forward to further progress on the substance of the pandemic agreement and improved dialogue among member states to arrive at a meaningful, effective result.”
Michelle Childs, Policy Advocacy Director for the Drugs for Neglected Diseases initiative (DNDi) welcomed the sharing of draft texts and daily briefings.
“These help to improve the ability of stakeholders to follow and input and counter misinformation about what is actually being discussed. We encourage further steps to enhance transparency, including making stakeholder interventions publicly available.”
INB Co-chair from South Africa, Ms Precious Matsoso, suggested that there had been progress on various areas of the draft agreement, from research and development to sharing of benefits such as vaccines. After almost three years, countries are “now focused on the remaining and most critical elements” of the agreement.
“At the heart of the negotiations is recognition that collaboration among countries will ensure the world will not be left vulnerable in the face of future pandemics, while each and every country will maintain their sovereignty and control over national health decision-making.”
For more on efforts to reach an agreement and how the vaccine industry can align itself with this, join us at the Congress in Barcelona next month, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 20, 2024 | Global Health |
In September 2024, the European Medicines Agency (EMA) announced its recommendation to extend the indication of the smallpox and mpox vaccine Imvanex to adolescents from 12 to 17 years of age. Imvanex, Bavarian Nordic’s MVA-BN, is authorised in the EU for the protection of adults against smallpox, mpox, and disease caused by the vaccinia virus. The Committee for Medicinal Product for Human Use (CHMP) based this recommendation on interim results from a study comparing the effects of the vaccine in adolescents and adults.
Data-led expansion
Interim results indicate that the immune response in adolescents was comparable to adults, from which the authorities have inferred that the vaccine will “provide similar protection in adolescents to that expected in adults”. The safety profile was also comparable with no additional risk identified. EMA has requested the marketing authorisation holder to submit the results of this study by 30th May 2025 to further characterise the safety information for adolescents.
Although this is the first approval of MVA-BN as a smallpox,mpox vaccine for adolescents, Bavarian Nordic notes that a recombinant version of MVA-BN (Mvabea) received EMA approval in 2020 as part of a prime-boost regimen for the prevention of disease caused by Ebola virus in individuals aged 1 and older. This approval was based on studies involving more than 3,300 individuals, including over 800 children and adolescents aged 1-17 in Africa.
Implications for the response
EMA states that this assessment has “important implications” for the global mpox response. As EMA is the regulatory agency of record for the WHO prequalification of the vaccine earlier this month, the CHMP assessment constitutes the basis for WHO prequalification approval to “facilitate timely and increased access” in communities that need it most. The EMA’s assessment has also previously been considered by the DRC’s national regulatory authority for fast-track approval.
President and CEO of Bavarian Nordic, Paul Chaplin, applauded EMA for the “expedited” review and decision.
“This represents an important milestone in our efforts to make our vaccine available for all populations and will help improve access for some of the most vulnerable individuals mostly impacted by the ongoing mpox outbreak in Africa.”
For insights into the regulatory processes behind access to vaccines, including from senior representatives of EMA, join us at the Congress in Barcelona next month. Don’t forget to subscribe to our weekly newsletters for the latest vaccines news.
by Charlotte Kilpatrick | Sep 20, 2024 | Global Health |
In September 2024, Africa CDC offered congratulations to the Governments of Japan and the Democratic Republic of the Congo (DRC) for their agreement on the donation of Lc16 mpox vaccines and specialised inoculation needles. At a signing ceremony in Kinshasa, the two governments marked a “significant milestone” in their cooperation. These vaccines are a “critical boost” to DRC’s mpox response; Lc16 is the only mpox vaccine currently approved for children.
Lc16
The vaccine is derived from the Lister strain of vaccinia and contrasts to the replication-deficient vaccines like Modified Vaccine Ankara (MVA) by retaining most of vaccinia genome and being able to replicate at the site of inoculation. It is administered as a single dose through the scarification method, which involves scratching the skin before applying the vaccine solution. Studies in children suggested that the vaccine was safe and well tolerated, leading to licensure. However, the duration of immunity remains unclear.
Another tool for the fight
Africa CDC states that this donation comes “at a pivotal time” in DRC’s fight against the regional mpox outbreak. Since the declaration of a PHECS in August 2024, a “more coordinated international response” has evolved. Central to this response is vaccination, which is complicated by Africa’s “limited access to critical countermeasures”.
Director General of Africa CDC, H.E. Dr Jean Kaseya, is “deeply appreciative” of the ‘” of the “generous donation” of mpox vaccines and specialised vaccine needles to the DRC.
“This timely assistance will significantly bolster our ongoing efforts to contain the outbreak, and I am confident that this partnership will help mitigate the public health threat posed by mpox, not only in the DRC but across the continent.”
Japan’s Senior Deputy Minister for Foreign Affairs, Takeshi Akahori notes the increasing number of cases in the DRC and other countries, commenting that Japan is “monitoring the situation closely” with WHO.
“I hope that these vaccines and needles will contribute meaningfully to the fight against mpox.”
Join us at the Congress in Barcelona next month to engage with public health experts on current health threats and how vaccines can contribute to our response, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 18, 2024 | Global Health |
The Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund) announced in September 2024 that it is responding to a request from the government of the Democratic Republic of the Congo (DRC) for support in its mpox response. The Global Fund will provide US$9.5 million towards the emergency response in six of the highest transmission provinces (Equateur, Sud-Ubangui, Sankuru, Tshopo, Sud-Kivu, and Nord-Kivu) as well as Kinshasa, which is home to 17 million people.
DRC is fighting the world’s largest mpox epidemic, reporting 5,160 confirmed cases and 25 deaths since the beginning of the year. However, as testing capacity and availability are limited, the number of suspected cases could be up to five times the number of laboratory-confirmed cases. As the epidemiology of mpox evolves in “complex ways”, implications for prevention, preparedness, and response efforts also evolve. Furthermore, mpox is “increasingly being associated with HIV”, which heightens the risk of transmission, illness, and death. Thus, investment in mpox efforts helps to strengthen work on HIV, and vice versa.
Global Fund support
The support offered by the Global Fund contributes to specific priority areas on the government’s National Preparedness and Response plan:
- Enhancing disease surveillance systems with an emphasis on strengthening early warning capabilities and alert and response systems to detect, monitor, and respond to mpox and other disease outbreaks.
- Strengthening laboratory systems and diagnostics to increase case detection and stop the spread.
- Conducting risk communication and community mobilisation and engagement through the network of community health workers and community actors who are deployed for HIV, TB, and malaria prevention and awareness.
- Implementing infection prevention and control measures to protect health workers, including at the community level.
- Reinforcing country-level coordination, planning, and support for emergency response and operations.
- Strengthening the capacity of health facilities to provide primary care services and support future emergencies.
The support also complements the current collaboration between DRC’s ministry of health, Africa CDC, WHO, humanitarian organisations, and other key partners on efforts to “address the severe challenges to the public health system” in the east of the country, where the epidemic is “converging with risks of other infectious diseases”. The Global Fund has already contributed support in moving available stocks of personal protective equipment to the most affected provinces.
Today’s fight for tomorrow’s resilience
Dr Roger Kamba, Minister of Health and Social Welfare for the DRC recalled the “proven track record” of infectious disease control in the partnerships with the Global Fund and other health partners.
“Over the past two decades, the number of AIDS-related deaths and new HIV infections in DRC have reduced by more than 60%, through coordination and collaboration across all out partners.”
Dr Kamba is “determined to continue to work in the same manner for a strong response to mpox”.
“The fight against the current mpox epidemic is a top priority for our ministry, especially through the reinforcement of the community response. It is essential to recognise that by acting now, we are not only fighting mpox but also investing in the resilience and health security of tomorrow.”
Executive Director of the Global Fund, Peter Sands, reflected that people who live in “areas of conflict and crises” often encounter “significant barriers to accessing health services”.
“When a disease outbreak occurs in these places, the challenges are compounded. Strong systems of trusted community health workers, health educators, and other local responders are essential for stopping disease spread.”
Mark Edington, Head of Grant Management at the Global Fund, emphasised the importance of swift action in disease outbreak situations.
“Immediate intervention is crucial to strengthen systems for health and improve disease detection, surveillance, and response mechanisms, aiming to prevent further deterioration in health outcomes, particularly for women, children, and internally displaced persons.”
The Global Fund encourages other affected countries to assess their mpox needs and the consider the possibility of repurposing existing Global Fund investments.
To contribute to important discussions about effective allocation of funds for emergency responses and ensuring more resilient health systems, join us at the Congress in Barcelona next month. Don’t forget to subscribe to our newsletters here for the latest vaccine and global health news.
by Charlotte Kilpatrick | Sep 18, 2024 | Global Health |
In September 2024, Gavi and Bavarian Nordic announced an advance purchase agreement (APA) to secure 500,000 doses of MVA-BN mpox vaccine to be supplied to countries in Africa that are affected by the mpox outbreak. The doses are funded by Gavi’s First Response Fund and are for delivery in 2024. Bavarian Nordic will be ready to supply the vaccine doses after a supply agreement has been signed with UNICEF, which will deliver the doses.
The First Response Fund
Gavi’s First Response Fund was established in June 2024 to “make cash rapidly available” for the purchase of vaccines in health emergencies. It is available to Gavi-eligible countries in the early days of a pandemic or major health emergency. The Fund pre-positions up to US$500 million of surge financing for vaccine procurement ‘at risk’, which means funds are used to secure doses and “Gavi’s place in the queue” while manufacturers complete the final steps of regulatory approval and manufacturing scale-up.
Dr Sania Nishtar, Gavi’s CEO, commented that the First Response Fund was designed in collaboration with donors and partners “specifically to provide rapid early funding for emergencies such as mpox”.
“Using it today to fund the first direct transaction for vaccines in support of equitable access and the global response, just over a month since mpox was declared a public health emergency, takes us a long way towards our goal of protecting those most at risk.”
Dr Nishtar thanked donors for enabling Gavi to “act rapidly” by committing funds before an emergency occurred.
“We are committed to working with affected governments and our partners to turn these vaccines into vaccinations as quickly and effectively as possible and, over time, to build a global vaccine stockpile if sufficient funding is secured for Gavi’s work through 2030.”
Paul Chaplin, President and CEO of Bavarian Nordic, is pleased to sign the agreement and “strengthen our commitment to support Gavi and other global health partners” who demonstrate “strong leadership”.
“The doses secured through this agreement will significantly increase the availability of mpox vaccines for African countries, and we are pleased that Gavi has selected our MVA-BN vaccine, which has proven highly effective during the global mpox outbreak in 2022.”
For the latest on vaccine collaborations to ensure equitable access, get your tickets to join us at the Congress in Barcelona next month, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 17, 2024 | Global Health |
A statistical report from UKHSA and NHS England in September 2024 reveals a drop in childhood vaccination coverage in England in 2023-2024. The report uses data from the COVER (cover of vaccination evaluated rapidly) programme, which collates information for children aged 1, 2, and 5 by financial year. The UK routine childhood immunisation programme includes WHO Europe’s recommendations as well as others advised by the Joint Committee on Vaccination and Immunisation (JCVI) and defined by UKHSA.
Coverage details
6-in1
For the 6-in-1 vaccine (previously 5-in-1), which protects against diphtheria, pertussis, tetanus, polio, disease caused by Haemophilus influenzae type b, and hepatitis B, vaccination is scheduled at ages 8, 12, and 16 weeks.
Coverage at 12 months in England has remained below the WHO Europe target of at least 95% of children immunised; for 2023-2024, 91.2% of children were reported to have completed their primary course of 3 doses at 12 months. This is a decrease from the previous year, which was 91.8%, and a continued “downward trend” since a peak of 94.7% in 2012-2013. In the 2023-2024 period, 8 out of 9 regions exceeded 90%, with 1 region (North East) exceeding the national target of 95%, reaching 95.2%. London had the lowest coverage of 86.2%.
Coverage at 24 months was 92.4%, lower than the previous year, which reached 92.6%, and continuing the “downward trend” since the peak at 96.3% in 2012-2013. This has not exceeded the target since 2018-2019. For regional coverage at 24 months, 8 out of 9 regions reached 90% coverage and 1 region met the national target of 95%. Again, London had the lowest regional coverage (87.7%).
At the 5-year coverage assessment, coverage was 92.6%, lower than the 93.2% coverage reported for the 5-in-1 vaccine in 2022-2023. This is the lowest since 2009-2009. However, at regional level, coverage exceeded 90% in 8 of 9 regions with the South West exceeding the 95% target. Once more, London had the lowest coverage (86.9%).
MMR
The MMR vaccine protects against measles, mumps, and rubella; doses are scheduled at 12 months (MMR1) and 3 years and 4 months (MMR2). Coverage is measured at 24 months (MMR1) and 5 years (both doses).
MMR1 coverage at 24 months reached 88.9% in 2023-2024; this is a decrease from 89.3% in the previous year and is the third consecutive year that coverage has been below 90%. For the 10 years between 2011-2012 and 2020-2021, coverage exceeded 90%. Regionally, 6 out of 9 regions reached 90% coverage, but no region met the national target of 95%. London had the lowest coverage (81.8%). At 5 years, MMR1 coverage was 91.9%, a decrease from 92.5% the previous year. 95% was achieved for the first and only time in 2016-2017; coverage has “consistently decreased” since then. The North East was the only region to meet the target of 95%.
MMR2 coverage at 5 years reached 83.9%, a decrease from 84.5% the previous year. Coverage decreased in all regions; no regions exceeded 90% coverage. The lowest coverage was in London (73.3%).
Rotavirus
The rotavirus vaccine is administered at 12 weeks and coverage is measured at 12 months; unlike other vaccines in the primary schedule, the rotavirus vaccine cannot be given beyond 6 months. This means that coverage at 12 months is “likely to be lower” than other vaccines.
National coverage at 12 months was 88.5%, a decrease from 88.7% in the previous year. This means that rotavirus vaccine coverage is “now at its lowest level since data became available” in 2016-2017. In 4 regions, coverage exceeded 90%, but none achieved 95%. London was the region with the lowest coverage at 83.6%.
PCV
The pneumococcal conjugate vaccine (PCV) protects against pneumococcal disease. The primary course is scheduled at 12 weeks and the booster dose at 12 months; coverage is measured at 12 months and 24 months.
The primary course coverage at 12 months was 93.2%, a decrease of 0.5% from 2022-2023. The booster coverage reached 88.2%, a decrease from 88.5% the previous year and a continuation of the downward trend since it peaks in 92.5% in 2012-2013. 5 out of 9 regions reached 90% coverage for the booster, but no regions exceeded the national target of 95%. London had “consistently lower coverage” between 2021-2024 and achieved 80.4% in 2023-2024.
Hib/MenC
The Hib/MenC vaccine protects against Haemophilus influenzae type b (Hib) and meningococcal disease group C (MenC). The combined vaccine is administered at 12 months, with coverage measured at 24 months and 5 years. It includes a booster for Hib, which is offered within the DTaP/IPV/Hib/HepB primary course.
At 24 months, coverage in England remained below 90% for the third year; it has declined consistently since a peak of 92.7% in 2012-2013. 88.6% of children were reported as having received the Hib/MenC vaccine. 6 out of 9 regions reached 90% coverage and no region achieved 95%. The lowest coverage was 81.2% in London. At 5 years, coverage was 89.4%, a decrease from 90.4% the previous year. This takes coverage to its lowest point since 2011-2012. 7 out of 9 regions reached 90% but no regions met 95%. London had the lowest coverage at 82.5%.
MenB vaccine and booster
The MenB vaccine and booster protects against meningococcal disease (group b). It is a combined vaccine scheduled at 8 weeks with a booster at 12 months, and coverage is measured at 12 months and 24 months.
At 12 months, 90.6% received 2 doses; this is a decrease from 91.0% the previous year. London had the lowest coverage at 85.5%. At 24 months, coverage was 87.3%, a decrease from 87.6% the previous year. Again, London had the lowest coverage (79.3%).
Parents encouraged to seek vaccines
Responding the report, Minister for Public Health and Prevention Andrew Gwynne urged parents to “take up vaccinations to keep children safe”, particularly as they return to school or nursery this Autumn.
“Vaccines are our best form of protection against serious illness.”
Steve Russell, NHS National Director for Vaccinations and Screening is concerned that “too many children are still not fully vaccinated” against vaccine-preventable diseases that can cause “serious illness”.
“Vaccinations have been protecting children for decades and are offered free as part of the NHS routine immunisation programme, saving thousands of lives and preventing tens of thousands of hospital admissions every year.”
UKHSA Consultant Epidemiologist Dr Vanessa Saliba emphasised the importance of the drive to increase vaccine uptake so that “no child is left at risk of serious illness or life-long complications”.
“These vaccines offer the best protection as children start their journey into nursery and mixing more widely. Many who missed out on their vaccinations have already been caught up, but more needs to be done to ensure all those eligible are vaccinated.”
For more on ensuring uptake levels match the pace of vaccine innovation, join us at the Congress in Barcelona next month. Don’t forget to subscribe to our weekly newsletters for the latest vaccine updates.
by Charlotte Kilpatrick | Sep 17, 2024 | Global Health |
The first round of an emergency polio vaccination campaign in the Gaza Strip reached around 560,000 children under ten between 1st and 12th September 2024. WHO reported that the campaign delivered novel oral polio vaccine type 2 (nOPV2) to 558,963 children after the identification of circulating variant poliovirus type 2 (cVDPV2) in July and August 2024. The effort used an “extensive network” of teams, providing vaccinations at selected fixed sites. Mobile and transit teams engaged families living in shelter homes, tents, and camps for the displaced, and community workers raised awareness.
Efforts continue
The initial campaign target was 640,000 children, which WHO suggests may have been an over-estimate in the absence of an accurate survey and population displacement. The campaign used 473 teams, including 230 mobile teams, and 143 vaccination sites in central Gaza. This was followed by 91 fixed sites and 384 mobile teams in southern Gaza. The campaign concluded in northern Gaza, with 127 teams at fixed sites and 104 mobile teams. Each of the three phases was conducted under an “area-specific humanitarian pause” of nine hours daily, agreed to guarantee the safety of communities and health workers and ensure vaccination targets could be achieved.
749 social mobilisers engaged communities, encouraged families to vaccinate their children, and addressed concerns. Trained monitoring teams were deployed during the campaign to oversee the efforts, and a further 65 independent monitors will now cross-check the proportion of children vaccinated in the Gaza Strip to independently assess the level of coverage achieved in this first round. These monitors will need “safe, unimpeded access” to households, markets, transit points, and health facilities to check that children have purple dye on their little fingers, signifying vaccination.
The second round of the campaign is expected to follow in four weeks, providing a second dose of nOPV2. WHO, UNICEF, and UNRWA hope to reach enough children and stop further transmission, calling for another round of humanitarian pauses with “unimpeded access” to children in areas that require special coordination. The organisations highlight the need for a “long-lasting ceasefire” so that families can “begin to heal and rebuild their lives”.
Public engagement
WHO recognises the “traditionally positive health seeking behaviour among the Palestinian people” as critical to the success of the first round. Families reportedly “flocked” to health facilities to ensure that their children received vaccinations. This positive reaction was complemented by an “impactful campaign to raise awareness and mobilise the public”.
Dr Richard Peeperkorn, WHO Representative for the occupied Palestinian territory (oPt), commented on the “incredible resilience” of helath and community workers who carried out the campaign at “unprecedented scale and speed under the toughest conditions in Gaza”. Additionally, “swift action” from the Global Polio Eradication Initiative, from initial detection to campaign launch, “speaks to the effectiveness of the polio programme”.
“In areas where humanitarian pauses took place, the campaign brought not just vaccines, but moments of calm. As we prepare for the next round in four weeks, we’re hopeful these pauses will hold, because this campaign has clearly shown the world what’s possible when peace is given a chance.”
Jean Gough, UNICEF Special Representative in the State of Palestine emphasised the importance of carrying out the “ambitious campaign…quickly, safely, and effectively”. This will protect children in the Gaza Strip and neighbouring countries from “life-altering poliovirus”.
“The progress made in this first round is encouraging, but the job is far from done. We are poised to finish the task and call on all involved to ensure we can do so in the next round in four weeks’ time, for the sake of children everywhere.”
For insights into effective emergency vaccination campaign delivery and strategies to encourage uptake, get your tickets to the Congress in Barcelona next month, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 16, 2024 | Global Health |
In September 2024 WHO announced the establishment of an access and allocation mechanism for mpox medical countermeasures, including vaccines, treatments, and diagnostic tests. The Access and Allocation Mechanism (AAM) is intended to increase access to these essential tools for people at highest risk, ensuring that limited supplies are used “effectively and equitably”. This announcement comes after WHO declared the mpox outbreak a PHEIC in August 2024 and addresses one of the key International Health Regulations Emergency Committee’s recommendations: “equitable access to safe, effective, and quality-assured countermeasures”.
AAM
The AAM is part of the interim Medical Countermeasures Network (i-MCM-Net). Developed in response to “global vulnerabilities” exposed by the COVID-19 pandemic, i-MCM-Net enhances collaboration through a “Network of Networks” approach. It seeks to provide timely and equitable access to quality, safe, effective, and affordable medical countermeasures in response to public health emergencies through existing networks and global collaboration. The network was endorsed by WHO Member States as an interim mechanism while negotiations on a pandemic agreement continue.
The mpox AAM includes members of the i-MCM-Net as well as WHO: Africa CDC, CEPI, the EU Health Emergency Preparedness and Response Authority (HERA), FIND, Gavi, the PAHO Revolving Fund, UNICEF, Unitaid, and others. It will work to allocate the “currently scarce supplies” to those at highest risk of infection.
It will operate according to three guiding principles:
- Preventing illness and death – prioritise vaccination and other tools to interrupt transmission for those at greatest risk to prevent illness and death.
- Mitigating inequity – ensure equitable access to medical countermeasures for all people at risk, irrespective of socio-economic or demographic background.
- Ensuring transparency and flexibility – establish and maintain clear and open communication about allocation decisions and be ready to adapt strategies as new data emerge or situations change.
More than 3.6 million vaccine doses have been pledged for the mpox response, including 620,000 doses of MVA-BN pledged to affected countries by the European Commission, Austria, Belgium, Croatia, Cyprus, France, Germany, Luxembourg, Malta, Poland, Spain, and the United States of America, as well as Bavarian Nordic. Japan has pledged 3 million doses of the LC16 vaccine. This is the largest pledge so far.
International coordination
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, recognised the need for “powerful tools” like vaccines, therapeutics, and diagnostics, to bring the mpox outbreak “under control”.
“The COVID-19 pandemic illustrated the need for international coordination to promote equitable access to these tools so they can be used most effectively where they are most needed. We urge countries with supplies of vaccines and other products to come forward with donations, to prevent infections, stop transmission, and save lives.”
Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme, emphasised that WHO and its partners are working with the government of the Democratic Republic of the Congo and other affected countries to “implement an integrated approach to case detection, contact tracing, targeted vaccination, clinical and home care, infection prevention and control, community engagement and mobilisation, and specialised logistical support”.
“The AAM will provide a reliable pipeline of vaccines and other tools in order to ensure the success on the ground in interrupting transmission and reducing suffering.”
Join us at the Congress in Barcelona next month to share your insights on the best ways to ensure equitable access to essential medical countermeasures, and don’t forget to subscribe to our weekly newsletters for the latest vaccine news.
by Charlotte Kilpatrick | Sep 16, 2024 | Global Health |
WHO Africa announced in September 2024 that more than 1,400,000 doses of human papillomavirus (HPV) vaccine have arrived in Angola as part of the national strategy for prevention and protection against cervical cancer. HPV is recognised as the “leading cause of more than 90% of cervical cancer”, but all approved vaccines are “highly efficacious” in preventing infection with virus types 16 and 18, with some conferring protection from additional types. Another batch of vaccines is expected in the coming days to bring the total number of doses to 2.2 million. This will ensure immunisation of around 2,136,000 girls between the ages of 9 and 12.
Preventing cancer
WHO Africa comments that cervical cancer is a “severe public health problem” that disproportionately affects African women; it affects five times more and kills seven times more African women than women in developed countries. WHO estimates that around 117,300 women in Africa are diagnosed with cervical cancer each year. More than 76,000 die from the disease.
Data from the Angolan Cancer Control Institute show that 915 cases of cervical cancer were treated in Angola in 2022. This number represents around 17% of all cancer cases in the country. However, the health authorities suggest that the actual incidence is higher, with cases going undetected due to “diagnostic limitations”.
Vaccination efforts
Angola is responding with urgency; the government has “boldly” acquired CECOLIN vaccines, manufactured by the INNOVAX laboratory, to reach 2,136,000 girls in a few weeks. The vaccine received WHO prequalification in 2021 for single-dose administration; it is considered “highly effective and safe”. More than 50 million doses have already been administered worldwide.
Alongside these vaccines, the government and partners are working to “consolidate other aspects” of the campaign, including planning and financing, training health workers, and engaging communities. The operation requires an estimated budget of US$20,926,809 and will involve vaccination in two phases at schools and communities.
Angola’s Minister of Health Dr Silvia Lutucuta stated that the vaccination campaign “represents a commitment by the Angolan Executive to protect the health and future of our girls”. The strategy is in line with the Global Strategy, contributing to a “healthier and more economically sustainable population”.
“This is a unique opportunity to protect future generations from a devastating disease. Let’s join forces and ensure that all girls in Angola, regardless of where they live, receive this life-saving vaccine.”
Acting WHO Representative in Angola, Dr Zabulon Yoti, recognised the “significant step” taken by the government to ensure that “Angolan girls grow up in a world where cervical cancer is a preventable disease, not a death sentence”.
“Now is the time to unite and support the initiatives underway to vaccinate our girls, drastically reduce the incidence of cervical cancer, and build a healthier future for the Angolan population.”
Antero Pina, UNICEF Representative in Angola, described the introduction of the vaccine as “another opportunity to transform the lives of adolescent girls”.
“This measure goes beyond the prevention of cervical cancer as it can promote other critical sexual and reproductive health interventions, thus making a further contribution to promoting and protecting the well-being of girls in Angola.”
Sustainable Development Goals
UN Development Programme Resident Representative in Angola, Dr Denise António, acknowledged funding from the European Investment Bank (EIB) and the government’s commitment to preventing cervical cancer. This is a “significant” milestone in national population health goals and the Sustainable Development Goals.
“By vaccinating these girls, we are safeguarding their future and contributing to the Sustainable Development Goals (SDGs). This milestone symbolises the strength of our joint commitment. It reflects the alignment of interests between the main partners involved, contributing to Angola’s National Development Plan 2023-2027 objectives and the 2030 Agenda.”
For the latest on vaccination strategies to protect populations around the globe, get your tickets to join us at the Congress in Barcelona next month and don’t forget to subscribe to our weekly newsletters here.
